Office visit, established patient (20-29 min)
Facility: Wichita County Health Center
Billing Code: 99213 (CPT)
- CPT Billing Code: 99213
- Insurance Median: $115
- Cash Discount Price: $92
- vs. Medicare Baseline: 1.21x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $95.19 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $95 - $339 | 100% |
| UnitedHealthcare | $115 | 121% |
Consumer Guidance & Cost Commentary
For this office visit at Wichita County Health Center in Leoti, Kansas, the negotiated rate for established patients is $115.00, which matches the facility's median negotiated rate exactly. While Medicaid / KanCare plans range from $95 to $339, UnitedHealthcare has a fixed negotiated rate of $115.00. It is important to note that the cash price for this service is $92.00, which is lower than the negotiated rates for both payers. Patients with high-deductible plans or those without insurance may find paying the cash price of $92.00 more cost-effective than relying on insurance, as the negotiated rates exceed the cash amount. Additionally, patients should inquire about "prompt-pay" discounts, which can further reduce the final bill if paid in full upfront, bypassing the administrative costs associated with insurance claims processing.
The Medicare benchmark for this procedure is $95.19, serving as a baseline for fair pricing. The facility's cash rate of $92.00 is slightly below the Medicare amount, while the negotiated rates are higher, reflecting the administrative overhead and contract structures typical of commercial insurance. This facility is a Critical Access Hospital owned by the local government, and while specific state or county average comparisons are not provided in the data, the cash price remains competitive relative to the Medicare baseline. To ensure you are not overcharged, it is recommended to request an itemized bill before payment to verify that no unbundled codes or services not rendered have been included. Always confirm with the billing department regarding any self-pay or prompt-pay discounts before scheduling your appointment to maximize potential savings.